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Innovation in Hospital Communication

Session 108, February 21, 2017

Tom Stafford, Vice President & CIO

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Speaker IntroductionTom Stafford, Vice President & CIOEducation:

Bachelors of Science Aerospace Engineering

Masters of Science Mechanical Engineering

Career:

United States Navy

Medical Device Design and Manufacture

Healthcare IT

IT Accolades:

10th Best Place to work in IT 2015 – Computerworld

2nd Best Place to work in IT 2016 – Computerworld

Premier 100 Technology Leaders 2017 - Computerworld

Add Speaker

Photo Here

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Conflict of Interest

Tom Stafford, BSAE, MSME

Has no real or apparent conflicts of interest to report.

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Agenda• Learning Objectives

• About Halifax Health

• Clinical Communication Challenges

• Requirements and Solutions

• Solution Selection: Cause and Effect Matrix

• Emergency Department Clinical Communication Strategy

• Clinical Unit Communication Strategy

• New Challenge and Next Gen Strategy

• Seamless Communication

• Innovation Examples

• Improved Communication by the Numbers

• Communication Value

• Key Learnings and Next Steps

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Learning Objectives

• Assess the risks of poor and inefficient clinical communication in terms of patient safety, confidentiality and HIPAA complinace

• Identify the most efficient and effective methods for communicating specific clinician-to-clinician information, including secure text messages, alerts, two-way or one-to-many conversations

• Evaluate the impact of enhanced clinical communication on both the provider experience/satisfaction and the patient experience/satisfaction

• Compare the “standard” to the “streamlined” communications workflow that reduces the clinical communication process from 10-12 steps to approximately four

• Measure the ROI across several areas, including patient safety, timeliness of care, clinician satisfaction, and patient satisfaction

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• Enables instant two-way and one-to-many conversations

• Makes it fast and easy for clinical staff members to locate colleagues

• Saves steps, greatly reduces the distances that staff walked each day

• Saves time that staff can spend at the patient bedside on direct care

• Improves nurse-physician communication and relationships

• Increase compliance and security

• Creates a quieter healing environment

• Streamlined clinical workflows

• Improves staff response times

• Improved patient experience

Benefits of Clinical Communication - STEPS

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About Halifax Health

Halifax Health Medical Center - Port Orange

– Opened in 2006

– 80 bed community hospital

– 20 bed emergency department

– 8 bed intensive care unit

Halifax Health Medical Center – Daytona Beach

– Opened in 1928

– 598 beds

– 500+ physicians

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More About Halifax Health• Emergency Department

– Largest in Florida: 99,000 square feet, 102 treatment rooms– Area’s only Level II Trauma Center– Area’s only Pediatric Emergency Department

• Area’s only Neonatal Intensive Care and Pediatric Intensive Care Unit

• Center’s for Neurosciences, Cardiology, Oncology, and Orthopedics

• 14 Provider Offices/Clinics with more opening soon

• Halifax Health Hospice

– Area’s largest Hospice Program– Four Inpatient Care Centers

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Why do they exist?

• Hospitals are sprawling and expansive

• The Electronic Health Record (EHR) is not the answer

The outcome of inefficient communication:

• Delays and gaps in care because of EHR data entry

• Patient Care, Safety and Satisfaction is not optimal

• Patient privacy violations

Clinical Communication Challenges

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Clinical Communication Players

Physicians Nurses

Pharmacy Radiology Respiratory

Trauma

Leadership

EKG/EEG

EVS

Blood

Bank

Dietary

RegistrationCase

Management

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• Largest Emergency Room in Central Florida

• Overhead paging disruptive to patient care and satisfaction

• Clinical Units are the size of a football field

• Difficult for care team members to locate each other and communicate

• Healthcare Information System Alerts only to the computer

• Smart Phones and the beginning of unsecure texting

• Central operator system slowed communication process between Providers and Nurses

Halifax Health’s Clinical Communication Challenges

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• Homogenous Enterprise Wide Communication Platform

• Efficient, Hands Free Communication for Nursing

• Patient Specific Alerting to the Applicable Caregivers

• Provider to Nursing Communication

• Secure Texting

• Improve Patient Satisfaction by removing Overhead paging

Challenges transform to Requirements

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Possible Solutions

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Solution Selection: Cause and Effect Matrix

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Tuesday -1:00-2:00 Session Selection

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Solution Selection: Cause and Effect Matrix

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Emergency Department Clinical Communication Strategy

• Evaluated clinical

communication

processes and

supporting

technologies

• Implemented

wireless hands-

free voice calling

for ED clinicians

and staff

• Eliminated

overhead paging

• Created very

quiet ED, a

more healing

environment

• Improve

workflow,

communication

for care team

members

• Positioned the

hospital as the

ED of choice for

the community

• Interest spread

quickly, widely

• ALL ‘mobile’ staff

equipped with

hands-free,

wireless, and

voice-controlled

communication

badges

Approach Results Expansion

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Clinical Units Communication Strategy

• Implemented

wireless hands-

free voice calling

for clinicians and

staff on Nursing

Units

• Utilize Staff

Assignment

• System Alerts to

Badges

• Improve

workflow,

communication

for care team

members and

ancillary staff on

Nursing Units

• Automatic Call

Escalation

• Instant

notification for

System Alerts

• Interest spread

quickly, widely

• ALL ‘mobile’ staff

equipped with

hands-free,

wireless, and

voice-controlled

communication

badges

• Alert Committee

formed

Approach Results Expansion

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New Challenge and Next Gen Strategy

• Physicians turned

to unsecure

methods of

communication,

text messaging

• HIPAA security

violation and risk

• Potential liability

for the hospital

and the

physicians

• Complex

communication

workflow among

clinical teams,

call center,

physicians

• Delays in

responding to

patients’ needs

• Poor experience

for patients,

clinicians and

staff

• Automate and

optimize clinical

communication

workflows

• Enable secure

communication

• Increase staff

response times to

patient requests

New Challenge Drivers for Risk IT-Led Solution

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Seamless Communication

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Hands-free Communication, Secure Texting, EHR

Integration, Alerts and Notifications

• Hands Free Communication Badge

• Badge and EHR Integration

• Badge and System Integration

• Secure Texting App

• Secure Web Texting Console

Enterprise Communication Strategy

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• Opened in June 2009

• Largest ED in Central Florida

• 99,000 square feet

• Pod Based

• 102 beds

• 120,000 annual admissions

• 110+ Communication Badges in use

Halifax Health Emergency Department

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Recorded after Hurricane Matthew

• ED Census: 67

ED Clinical Communication

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• 36 Bed Unit

• Units are the size of an

Football Field

• Prior to Communication

Badges, the Nurse

Managers were withering

away

• Utilize Staff Assignment

• Can accept external calls

Clinical Units Communication

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Clinical system integration delivers the right information to the right person at the right time and place.

EnhancePatient Safety

Increase Patient Satisfaction

Improve NurseResponsiveness

Improve Workflow Efficiency

Non-EHR

Impact of Integrated Systems

Mobile Communication

SystemEHR

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Alert Data FlowHealthcare

Information

System

Sepsis

Alerting

System

ED

Throughput

System

Data

Analytics

Engine

Integration

Engine

Bed

Tracking

System

Badge &

Smartphone

App

Direct Interface

Patient Specific Orders, ADT, Results, &

Alerts

API to API

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Intelligent Integration: HCIS to Badge

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Intelligent Integration: Sepsis Alerting to Badge

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Clinical Workflow Optimization

Nurse Calls Call

Center

Call Center Calls

physician

Conveys

information

Does the

physician

answer?

Either physician or

Call Center calls

nurse

Has physician

called floor?

YES

Nurse acts on

instructions

NOCall Center calls

physician againNO

May call physician

again or call the

back up physician

Does physician

answer?

YES

NO

YES

Nurse sees if

physician is

available in

Vocera

Nurse texts

physician using

Web Console

Physician reads

text

Physician

responds by either

text or voice call

badge

CURRENT STATE

USE CALL CENTER

FUTURE STATE

USING VOCERA COLLABORATIVE SUITE

NURSE TO PHYSICIAN COMMUNICATIONS

Waits for specified

time, if physician

has not called back

will contact nurse

NO

Original Workflow

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Clinical Workflow Optimization

New Workflow

Nurse Calls Call

Center

Call Center Calls

physician

Conveys

information

Does the

physician

answer?

Either physician or

Call Center calls

nurse

Has physician

called floor?

YES

Nurse acts on

instructions

NOCall Center calls

physician againNO

May call physician

again or call the

back up physician

Does physician

answer?

YES

NO

YES

Nurse sees if

physician is

available in

Vocera

Nurse texts

physician using

Web Console

Physician reads

text

Physician

responds by either

text or voice call

badge

CURRENT STATE

USE CALL CENTER

FUTURE STATE

USING VOCERA COLLABORATIVE SUITE

NURSE TO PHYSICIAN COMMUNICATIONS

Waits for specified

time, if physician

has not called back

will contact nurse

NO

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Clinical Workflow Optimization in Action

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• Active Badges: 733

• Voice Badge Licenses: 500

• Secure Texting App Licenses: 300

• Total Users: 3282

Improved Communication by the Numbers

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• Average Active Badges: 440

• Total Annual Calls: 2,005,634

• To Badge User – 89%

• To Groups – 10%

• To Phone – 1%

• Text Messages (6 months): 16,194

• Alerts (6 months): 17,921

Improved Communication by the Numbers -Adoption!

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• Enables instant two-way and one-to-many conversations

• Makes it fast and easy for clinical staff members to locate colleagues

• Saves steps, greatly reduces the distances that staff walked each day

• Saves time that staff can spend at the patient bedside on direct care

• Improves nurse-physician communication and relationships

• Increase compliance and security

• Creates a quieter healing environment

• Streamlined clinical workflows

• Improves staff response times

• Improved patient experience

Benefits of Clinical Communication - STEPS

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Increased valuable time that care team

members spend at the patient

bedside delivering

direct care.

Impact on Patient Experience

Decreased patient wait time

by reducingdischarge process

time by 8% on oncology unit.

Patients home sooner.

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Improved

reliability of delivering orders,

and improved order-to-response

turnaroundtimes

Impact on Patient Safety and Care

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Improved Safeguards for

PHIprovided more

security for physicians, and

increased compliance with

regulations

Impact on Data Security

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Impact on Savings

Improved bed turnover

rates and ensured beds

were available for patients

Reduced time resources,

and materials needed to print

and retrieve paper orders

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• Understand Needs of Each Stakeholder

• Change is difficult in Healthcare: Incremental Steps and Persistence

• Be flexible and willing to consider clinical and patient needs as you progress

• Include clinical staff in planning discussions

• Pilot a Unit before Enterprise Deployment

• Ensure IT personnel are on the floor with

clinical teams to see how they interact

with each other, physicians, and patients

Key Learnings

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InnovationLeverage the power of effective communication in achieving clinical excellence

Patient Quality Outcomes - Decrease mortality

Additional HCIS patient specific alerts to Caregivers

Rapid Response Team communication coordination

All Codes and Critical Alerts sent via badges or mobile devices

1.Code Blue

2.Stroke Alert

3.STEMI Alert

4.Early clinical response to decompensating patients

Patient Quality Outcomes - Patient Satisfaction

Remove overhead paging on clinical units

Next Steps

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Patient Quality Outcomes - Reduce Readmissions

Achieve quality care management through improved coordination of care and effective communication with patient and caregiver engagement.

Effective communication with

Physicians

Nursing

Care coordinators (disease specific navigators)

Pharmacists

case management

Social worker

Physical, occupational, speech, and respiratory therapists

Patient

Patient’s caregivers and social support

Next Steps

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Patient Quality Outcomes

Performance Improvement, New Quality Initiatives, Information system, & Process Changes

Next Steps

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Questions

Tom Stafford

tom.stafford@Halifax.org

386-425-7309

https://www.linkedin.com/in/tom-stafford-8a69927